The Concussion movie follows the tragic story of a forensic neuropathologist from Nigeria (played by Will Smith) who discovers brain damage in deceased NFL legend, Mike Webster. When Dr. Omalu publishes his findings he receives personal and professional condemnation from colleagues and the NFL. It is not until Dr. Omalu enlists the help of Dr. Julian Bailes – neurological consultant to the NFLPA since 1994 (played by Alex Baldwin) and publishes similar findings of CTE in three other deceased former NFL players (Terry Long, Justin Strzelczyk and Andre Waters) that his research begins to gather national attention. In the end of the movie Concussion, Dr. Omalu is finally vindicated by former NFLPA executive Dave Duerson who commits suicide as a result of cognitive impairments. Duerson stated in his suicide note, that Dr. Omalu was right.

The purpose of this piece is not to discuss the research behind CTE; I have done this ad naseum in another post. My goal is to talk about the take home message of the movie Concussion and what it might mean for minor league sports, not just football.

Concussion Movie and Chronic Traumatic Encephalopathy

One of my criticisms with the Concussion movie is that is not about concussions, rather chronic traumatic encephalopathy (CTE). However, before I continue I feel it is my responsibility to quickly summarize the research surrounding CTE.

Repetitive Head Trauma and Concussions (CTE)

Dr. Julian Bailes emphasizes CTE is a result of repeated, minor head trauma (subconcussive impacts), as opposed to the more violent hits that lead to a concussion. However, it is still unknown whether repeated hits to the head cause tau protein deposition.

Tau Proteins and CTE

Tau proteins are the smoking gun behind CTE research. There are 20 different conditions where tau proteins accumulate in the brain. CTE Tau protein levels are similar to epileptic patients. The location of tau proteins in CTE is similar to epileptic and normal populations. Tau pathology has not been shown to cause complex changes in behavior, such as: depression, substance abuse, suicidal tendencies, personality changes or cognitive impairment.

Suicide Rates and Concussions (CTE)

In fact, suicide rates among NFL players, current and retired are lower than the general population of U.S males. Due to these findings some authors argue there is no clinical syndrome unique to CTE. Furthermore, the diagnosis is made post mortem and the research quality is poor. The history of behavioral impairments in CTE patients relies heavily on next of kin testimonials. To summarize, we don’t know what we know and more research is needed.

Playing Minor Sports and Development of CTE

The fact that the research is not as overwhelming as what the Concussion movie suggests is my biggest concern with the take home message. I feel that movie goers will leave with an impression that every person who plays minor sports will develop CTE – this is unsubstantiated. This point hits home for me as my brother was forced to give up playing hockey because he sustained too many concussions. According to Dr. Omalu, CTE develops 8-10 years after retirement, so technically my brother could already have experienced behavioral changes consistent with CTE.

Prevalence of CTE

In an interview with Time, Dr. Omalu stated that he believes over 90% of NFL athletes will suffer from CTE at some point in their life. When asked about the prevalence of CTE, Dr. Bailes stated that current studies use a highly selective group and he believes that only a minority of NFL players will develop CTE, but insisted we don’t know what the exact number is.

“I don’t think he has any facts or experience or research in youth football to make that statement…football is safe as long as the players and their parents understand the risk and the pros and cons…benefits and potential risk of participating…it’s a personal decision … I don’t think the facts support that there are cases of CTE from youth football participation.”

Football is not the only sport that experiences concussive and subconcussive impacts. After football, the sports that have the highest rates of concussions are hockey (girls then boys), rugby (boys and girls), boys lacrosse and girls soccer. This statement effectively means that we should abandon every minor league organization because of a subject matter that needs a lot more research. Do not get me wrong, research on concussions and CTE is imperative and organizations like the NFL and NHL need to do a better job of supporting it.

Rule Changes and Concussion Prevention

Nevertheless, I feel that we need to embrace rule and policy changes instead of abandoning minor sports. Hockey Canada has already embraced this philosophy and has a strict no hits to the head policy. Body checking in Ontario minor hockey has been moved from age 11-12 to 13-14, and only higher skilled players are allowed to body check. This last rule change is important because a study published in BJSM last month, found that if body checking was only allowed in elite 11-12 minor hockey players as opposed to non-elite players then there is a threefold reduction in concussions. Some soccer organizations are looking at removing heading the ball. A football organization in Ontario is looking at eliminating kick-offs. While research is needed to prove which rule and policy changes have the greatest reduction on concussions, it is the organizations willingness to adapt that should be commended.

Baseline Testing and Concussion Management

Policy and rule changes are a good way to reduce concussions but coaches, trainers, parents, athletes and teachers need to be educated on the signs and symptoms of concussions. Players also need to have baseline concussion testing so that they can return to sport at a safe time. This is where a company like Complete Concussion Management (CCM) is so vital. CCM has an app for coaches, teachers and parents, offers baseline testing and concussion management.

“The biggest thing is avoiding unnecessary hits to the head…that’s been done at every level …from the NFL down to youth football…avoiding unnecessary hits in practice…enforcing rules…about head-to-head hits and purposeful hits to the head. It’s also about education and teaching the signs and symptoms of concussions to athletes and coaches.” – Dr. Julian Bailes